There is a beautiful and healthy design to birth, babies and breastfeeding. They are designed together, integrally related to each other. Birth, babies and breastfeeding are also integrally designed together with the mother. For example, the baby’s stomach size at birth matches the mother’s colostrum output (the breasts’ first milk). And each day subsequent to that, the baby’s stomach grows and the mother’s milk output correspondingly increases, matching that stomach capacity!
You see, over the first three days of life, babies are learning many things about their new life outside of the womb. One of these tasks is learning to coordinate sucking, swallowing, and breathing. We have spoken about the small amount of the first milk available to them, as well as its thick sticky nature. These two properties make it less likely to be regurgitated by the new baby, and if it is, its stickiness means it is less likely to flow into the baby’s lungs. After three days, the milk becomes more fluid, and is in greater quantities, but the baby has learned to coordinate sucking and swallowing the milk along with interspersing his or her breaths.
We have discussed this regarding its protection for the respiratory status of the newborn. The fact that it is concentrated also means the baby gets a lot of substance while accommodating his small stomach size. But what about his fluid needs? For this, babies are designed with a layer of fluid under their skin. They are born with this layer of fluid and utilize this fluid store over the next 3-5 days for their fluid needs. As we have discussed, it is during this time that their stomach is growing in size and their mother’s milk is growing in volume. After these few days, the mother’s milk changes to become more fluid, supplying all the fluid needs of the baby, while the baby’s stomach has grown to accommodate the increased volume, and the fluid stores have been depleted (this accounts for the normal and healthy weight loss the baby experiences over the first 3-5 days, approximately 7-10% of the baby’s birth weight). We see these changes in the mother, the baby, and the milk all happening in concert with each other.
Why is this so? There is a design. The design works best when we work with it. Birth is a normal, healthy life event; it is not broken so doesn’t need fixing. It is not inherently unsafe so doesn’t need rescuing. The same applies to babies and breastfeeding. When you work with the design, you find that it works. This is not to say that there aren’t problems sometimes.
The colored areas represent 95% of the curve. This represents what is normal. The white areas are the “tails.” This 2.5% at each end adds up to a total of 5%. This represents when something falls out of normal and needs intervention. This means for the most part birth and breastfeeding are normal healthy processes undertaken by normal healthy people. When the rare event happens that it falls out of normal, or a complication arises, then it becomes healthy to intervene and it is prudent to do so to restore health. But when we mess with that which is inherently normal and healthy we induce a state of ill health and abnormality.
See this demonstrated so poignantly in the US standings in the world infant morbidity/mortality scale: from 17th in 1984, to 25th in 2004, to 33rd in 2006, meaning in the United States, birth outcomes are worse for babies now than before. Since 1950, medical technology has helped to reduce infant mortality, but the United States still has a relatively poor global standing. In 2010, the United States ranked 32nd among the 34 nations of the Organization for Economic Cooperation and Development in infant mortality, and the overall infant mortality rate was three times that of the countries with the lowest infant mortality rates: Iceland (2.2 per 1,000), Finland (2.3), and Japan (2.3) (1, 2). In 2013, it was reported that the United States had the highest number of first day deaths, that is, the highest number of infants dying on their first day of life, than any other country in the industrialized world. See Figure 1. In The 2013 State of The World’s Mothers Report, the United States ranked number 30 for their high infant mortality rates. This is down five spots from the 2012 report.
The maternal mortality rate in the US has increased from 6 per 100,000 live births in 1990, to 9.1 in 1998, to 13.6 in 2006. And in California, the maternal death rate has tripled in the last ten years: from 5.6 in 1996 to 16.9 in 2006! This means that in the United States, and especially in California, birth outcomes are worse for mothers now that before.
We have taken normal healthy life events and messed with them, rather than working with the design, and so have induced an abnormal and unhealthy status upon it. When we mess with that which is normal and healthy, we then have to fix our messes. The mess is compromised health outcomes for mother and baby, either reflected directly in the health and well-being of mother and newborn, or indirectly, through undermining breastfeeding. And a fixed mess will lack the integrity and robustness of the original.
The cesarean section rate was 21% in 1996, rose to 26% in 2002, then increased to 32% in 2007. For reference, Ithe World Health Organization states that the cesarean section rate for sheer physiologic reasons should be 10-15%.
According to the National Center for Health Statistics, the rate of inductions was 9.5% in 1990. In 2003, the rate more than doubled to reach 20.6%. It is known that having an induction gives you a 50% risk for having a cesarean.
The US Dept of Health and Human Services says that routine intrapartum electronic fetal monitoring is not recommended for low risk women and that there is insufficient evidence regarding its routine use even in high risk pregnancies. Despite the fact that there is no evidence that it improves health outcomes, and the fact that the United States Preventative Services Task Force has recommended AGAINST continuous routine monitoring, it has still become common practice in the U.S. One survey in 2005 showed that 71% of women were continuously monitored throughout their labor. And it is even higher now. There are associated harms from this unnecessary practice: Women who are continuously monitored rather than intermittently monitored have higher rates of cesarean deliveries (3 times higher) and more forceps and vacuum extractions.
Studies show babies whose mothers had drugs or anesthesia in labor had lower scores on sucking measurements, and more trouble initially breathing. Babies whose mothers had cesarean sections have been shown to have increased respiratory illnesses even up to six years of age.
Women who had drugs or anesthesia in labor showed lower initial milk volumes, and those who had a cesarean had the lowest of all. Also, birth centers with higher rates of birth interventions, and higher rates of cesarean section , have mothers with longer delays until milk onset.
1) Birth, babies, and breastfeeding are all integrally designed along with the mother;
2) Birthing practices affect not only the birth, but the baby, breastfeeding, and the mother as well.
Lastly, birth is not just having a baby; it is also becoming a mother. Birth is the entry into motherhood!
What is this design? Can we know it? I have good news for you! Not only is this design knowable, it is also doable. Explore this website. There are many insights to discover that will prove helpful in understanding birth, babies, and breastfeeding. These insights will also be helpful for approaching a healthy and transformative entry into motherhood.
1. Organisation for Economic Co-operation and Development. OECD family database. Paris, France: Organisation for Economic Co-operation and Development; 2012. Available at http://www.oecd.org/social/family/database .
2. CDC Grand Rounds: Public Health Approaches to Reducing U.S. Infant Mortality Weekly, August 9, 2013 / 62(31);625-628; http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6231a3.htm?s_cid=mm6231a3_e
3. U.S. has highest first-day infant mortality out of industrialized world, group reports. CBS news. http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/
4. Surviving the First Day. STATE OF THE WORLD’S MOTHERS 2013. http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.8682793/k.EAB5/State_of_the_Worlds_Mothers_2013_Infographic.htm
5. The Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum; Mary Kroeger, Linda Smith; Jones & Bartlett Learning, 2004.
6. The Impact of Birthing Practices on Breastfeeding; Second Edition; Linda Smith; Jones & Bartlett Publishing, 2010.